Health technology assessment (HTA) has become an essential tool for supporting evidence-based decision making in health care systems worldwide. Comprehensive HTA reports, however, are resource-intensive and time-consuming, making them impractical for many decisions that need to be made at the local or institutional level. This gap has led to the development of more pragmatic approaches that aim to balance methodological rigor with feasibility. In Norway, this challenge was addressed through the introduction of mini-HTA, which is a structured, simplified, and context-specific decision-support tool to inform local or institutional decisions about introducing new technologies, procedures, or organizational innovations. Mini-HTA provides a standardized framework for evaluating clinical effectiveness, safety, organizational impact, ethical considerations, and economic consequences while remaining feasible for clinicians and managers to apply in practice. Several key insights emerge from our experience with developing and implementing mini-HTA in Norway. First, adapting HTA approaches to local decision-making contexts increases feasibility and uptake, particularly where time and resources are limited. Second, governance structures, including clear allocation of responsibilities and leadership engagement, are crucial for the consistent use of mini-HTA in practice. Third, the Norwegian experience illustrates how a shared but flexible tool can be applied across different levels of care, including both hospitals and municipalities, while still allowing for contextual adaptation. Finally, the use of mini-HTA as a platform for collaboration across sectors highlights its potential not only as a decision-support tool, but also as a mechanism for coordinating priorities and responsibilities across organizational boundaries.

The approach of Health Technology Assessment, which developed from the Evidence-Based Medicine movement of the 1990s, has proved its value in appraising the value of pharma products but presents methodological challenges when applied to medical devices and digital technologies, whose importance has increased enormously during the last 30 years. The concept of a single assessment, which can summarize relative effectiveness and cost-effectiveness, has been further challenged by the rapidly rising importance of software-driven devices, and latterly Artificial Intelligence. The need to adopt a broader evaluation approach based on product life cycles has been recognized by both regulators and HTA bodies, but practical frameworks for this have not yet been widely adopted. We describe a Life-Cycle-Based Evaluation (LCBE) approach to the assessment of Digital Health Technologies, developed as part of the ASSESS-DHT Horizon Europe 2020 project, EU project 101137347. The LCBE framework is currently being evaluated in pilot studies and aims to support early, proportionate, and continuous assessment and foster collaboration among developers, regulators, and HTA bodies to ensure timely, rigorous, and adaptive evaluations across the technology life cycle.

Real-world evidence (RWE) is reshaping how health technology assessment (HTA) bodies evaluate therapies, yet a critical gap persists: while transportability methods enable researchers to adapt treatment effect estimates from RWE studies in another jurisdiction to local contexts, the field remains unclear on when these analyses impact decision-making. This article synthesizes insights from HTA bodies, health technology developers (HTDs), and methodologists to clarify what is missing from today's transportability conversation. We find that methodological progress has outpaced guidance on its utility; HTDs risk investing in transportability analyses without clear evidence that they reduce key uncertainties or affect recommendations. We identify three fundamental gaps: the absence of objective thresholds for determining whether transportability assumptions are adequately met; limited guidance on when quantitative transportability is needed versus qualitative assessment; and variation in HTA bodies' evaluation and application of transported evidence. These gaps create a critical impasse where HTDs must decide whether to invest in such analyses, while HTA bodies lack standardized frameworks for their assessment. We argue that transportability cannot transition from academic exercise to a decision-making tool without explicit early dialogue between stakeholders, transparent reporting standards, and capacity building within HTA bodies. We present actionable recommendations to build HTA expertise, create a case study repository, and define contexts where transported RWE demonstrably impacts patient access. As evidence dossiers increasingly rely on nonlocal data, addressing these strategic and operational gaps becomes essential to help patients.